Archived: Dr Ajay Ramchandran

Updated 1 April 2016

The Spires Health Centre was established in 2006. Dr Ajay Ramchandran took over the practice in 2012 and Dr Divya Chikkaveeraiah joined as a partner in 2013. In 2014 a local practice closed and the Spires Health Centre patient list size grew from 3,600 patients to 4,800 patients. Forty four per cent of the patient population is aged between 15 and 44. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The clinical team includes two GP partners and a practice nurse. The GP partners and the practice manager form the practice management team and they are supported by administration staff who all cover reception and administration duties.

The practice is open between 8am and 8pm Monday, 7am to 6.30pm Tuesday and Wednesday, 8am to 6.30pm Thursday and Friday. Appointments are available from 8.30am to 11.30am, 3pm to 5pm and 6pm to 8pm Monday, 7.15am to 11.30am and 3pm to 5pm Tuesday, 7.15am to 11.30am and 3.30pm to 5.30pm Wednesday, 8.30am to 11.30am and 3pm to 5pm Thursday and Friday When the practice is closed during the out of hours period, patients receive primary medical services through an out of hours provider. The GPs also work an extra half day to manage demand for appointments.

Updated 1 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Spires Healthcare on 10 February 2016. Overall the practice is rated as good

Our key findings across all the areas we inspected were as follows:

• We noticed a strong theme of positive feedback from staff and patients. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Risks to patients were assessed and well managed. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice was proactive in identifying and managing significant events. All opportunities for learning were maximised.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. The strategy was regularly reviewed and discussed with staff.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• All patients who were registered with the practice had a named GP and patients could access appointments and services in a way and at a time that suited them.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was a clear leadership structure and staff felt supported by management. There were high levels of staff engagement and the management team motivated and encouraged staff to succeed.
• Staff recognised and respected people’s needs, and were highly motivated to provide care that is kind and supportive.

There were areas of practice where the provider should make improvements:

• Ensure staff receive regular appraisals of their performance to enable development needs to be identified and supported.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 April 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice arranged a diabetic education programme, led by a diabetic nurse specialist that spoke Punjabi and Bengali to provide advice and guidance tor patients from ethnic monitories.
• Clinical staff carried out home visits for older patients and patients who would benefit from these. Immunisations such as flu vaccines were also offered to vulnerable patients at home, who could not attend the surgery.

Updated 1 April 2016

The practice is rated as good for the care of families, children and young people.

• Baby and mothers first post-natal reviews for first set of immunisations were co-ordinated together to avoid duplicate visits to the surgery.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 1 April 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. All these patients had a named GP.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Immunisations such as flu and shingles vaccines were also offered to patients at home, who could not attend the surgery.
• The premises were accessible to patients with mobility difficulties.
• Patients at high risk of hospital admission were identified and reviewed regularly. 

Updated 1 April 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group, including health trainers’ clinics weekly.
• The practice offered text messaging reminders for appointments.

Updated 1 April 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice regularly worked with other health and social care organisations in the case management of people experiencing poor mental health, including those with dementia. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Performance for mental health related indicators was 92.3% similar to the CCG and national average 92.8%
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• Clinical staff carried out home visits for patients who would benefit from these. Immunisations such as flu vaccines were also offered.

Updated 1 April 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice regularly worked with other health and social care organisations in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.
• The practice held a register of patients living in vulnerable circumstances including homeless people, and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• Clinical staff carried out home for patients who would benefit from these. Immunisations such as flu vaccines were also offered at home, to patients who could not attend the surgery.